16-002077/AABS v Scottish & York Insurance Company
Jan 09, 2018
Adjudicator: Khizer Anwar
1. Do the applicant’s injuries fall under the Minor Injury Guideline?
2. Is the applicant entitled to a medical benefit in the amount of $4,273.00 for chiropractic services, as outline in the Treatment and Assessment Plan (OCF-18) dated August 24, 2015?
3. Is the applicant entitled to interest on the overdue payment of benefits?
1. The applicants injuries do not fall under the Minor Injury Guideline. An applicant is not mandated to produce the clinical notes and records of their treating health practitioner. It is left to the applicant to put forward the best evidence to support their claim. Based on the assessor reports provided the Tribunal is satisfied that the applicant was suffering from pre-existing chronic pain and that the subject accident contributed to the development of the applicants chronic pain.
2. The Treatment and Assessment Plan in dispute is not reasonable and necessary. The applicant failed to provide information pertaining to the treatment already received making it unclear as to why the proposed plan was necessary or different. The applicant failed to meet her onus and thus the denial is upheld.
3. The applicant conceded in her submissions that since costs of treatment have not been incurred, interest is not payable.